Provider Demographics
NPI:1124001375
Name:SIELSKI, JAMES ALAN (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:SIELSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1018
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-1018
Mailing Address - Country:US
Mailing Address - Phone:928-755-3515
Mailing Address - Fax:928-337-3780
Practice Address - Street 1:625 NORTH 13TH WEST
Practice Address - Street 2:
Practice Address - City:ST. JOHNS
Practice Address - State:AZ
Practice Address - Zip Code:85936
Practice Address - Country:US
Practice Address - Phone:928-337-3705
Practice Address - Fax:928-337-3780
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52486079OtherMEDICAID
AZ080193808OtherRAILROAD
AZ436205Medicaid